Total hip arthroplasty in very young patients aged under 21 years: A 25 year literature review (2000–2025)

Total hip arthroplasty (THA) in very young patients (aged <21 years) remains rare and challenging due to concerns about implant longevity and lifetime revision risk. Historically avoided, its use has increased over the past two decades thanks to advances in materials, fixation, and surgical techniques. A systematic review of PubMed/MEDLINE (2000–2025) identified 10 studies reporting outcomes of primary THA in patients aged 10–21 years, representing 3106 hips. Data on indications, implant design, fixation, bearing surfaces, complications, and functional outcomes were extracted and analyzed. The mean patient age at surgery was 17.7 years, with a mean follow-up of 7.7 years. The main indications were avascular necrosis (35%) and dysplastic osteoarthritis (33%). Uncemented fixation predominated (82%). A clear temporal shift in bearing use was observed: ceramic-on-polyethylene increased from 5% to 65% between 2000 and 2021, while metal-on-metal declined from 30% to 2%. The overall revision rate was 8.3%, with loosening (53%) and wear (12%) as leading causes. Five to ten year survivorship averaged 91.7%, comparable with adult benchmarks. Over the past 25 years, THA in very young patients has shown encouraging outcomes, with substantial functional gains and improved implant survival. Although lifetime revision risk remains, modern uncemented implants with advanced bearings appear durable in carefully selected cases. Continued long-term surveillance and registry-based studies are needed to refine implant selection and optimize management of early-onset hip disease. • Total hip arthroplasty in patients aged under 21 years is exceptional. • The principal indications are avascular necrosis and dysplasia-related osteoarthritis. • Mid-term outcomes are encouraging, with a pooled 5–10 year survivorship of 92%. • Future research must focus on long-term survival and return to work.